Lupus & antiphospholipid syndrome
Distinct pattern of comorbidities hinders treatment target attainment in systemic lupus erythematosus (SLE) through persistent disease activity and delayed glucocorticoid tapering: longitudinal data from a multicentre cohort study
Authors' conclusion
Patients with SLE manifest high comorbidity burden, with distinct patterns linked to reduced target attainment.
Study context
- Population
- Patients with active SLE receiving treatment intensification at inclusion (median age 46 years; median disease duration 9 months); median follow-up 5 years
- Participants
- 347 patients
- Exposure
- Comorbidities vs no comorbidities in active SLE
- ≥1 influential comorbidityn = 238
- Outcome
- Attainment of remission (DORIS) and lupus low disease activity state (LLDAS) in relation to comorbidities
Methodological detailsmulticentre, longitudinal, mixed-effects models, random forests, marginal structural models
- Multicentre
- Longitudinal
- Mixed-effects models
- Random forests
- Marginal structural models
Main finding
As reported in the abstract
DORIS/LLDAS attainment by comorbidity burden
Comorbidity burden (count, Rheumatic Disease Comorbidity Index, Elixhauser, Charlson) and DORIS attainment, ORs
0.77-0.87
p<0.05
Comorbidity burden and LLDAS attainment, ORs
0.74-0.91
p<0.01
≥1 influential comorbidity: lower likelihood of durable DORIS/LLDAS (≥50% time)
55-60%
Observational data: associations, not effects.
Further findings
Damage accrual
| IRR (95% CI) | ||
|---|---|---|
| ComorbiditiesAttenuated in patients with sustained DORIS/LLDAS | 1.38 (1.11–1.71) | |
| 0.512Incidence rate ratio (log scale) |
Marginal structural models: comorbidities-targets association
- Independent association regardless of prior achievement, explained by smouldering activity and delayed GC tapering
Treatment
- Immunosuppressant/biologic use comparable; comorbid patients received lower GC doses during high disease activity
Original publication
Distinct pattern of comorbidities hinders treatment target attainment in SLE through persistent disease activity and delayed glucocorticoid tapering: longitudinal data from a multicentre cohort study. RMD Open. Published 4 March 2026. doi:10.
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